Area of Research: Reproductive Health
Section 1: Summary of main strands/themes for research
Reproductive health can affect an individual’s physical and mental wellbeing, their work and social lives, and intimate relationships. Despite encompassing normal and universal processes, we know that significant disparities in reproductive health experiences, access to care, and outcomes exist. The new Reproductive Health Policy Research Unit (RH PRU) should aim to address these disparities and improve overall quality of care by prioritising research relating to:
- Health systems and new models of care, including digital provision and collaborative commissioning.
- Disparities in reproductive health service access and outcomes across geographies, protected characteristics, and inclusion health groups.
- User experience and preferences both within and outside of health services.
- Support for prevention and self-management, including information provision and impacts on decision-making.
The RH PRU should take a whole population, life course approach to reproductive health that is representative of society and explores the specific and intersecting needs of all services users, including groups who are currently under-represented in research such as trans and non-binary people and those from minority ethnic groups. The areas of focus across the reproductive health life course that the RH PRU should consider are:
- Menstrual and menopause health
- Pregnancy prevention, fertility (including links with sexually transmitted infections) and abortion
- Prevention, diagnosis and management of gynaecological conditions, including urogynaecology/ pelvic floor disorders
Examples of research topics could include:
- Evaluation of the ability of health technology/ apps to help women understand their hormonal fluctuations/ symptoms, to support self-management or access to health services.
- Public perceptions of new models of contraception provision including fertility tracking, postnatal contraception, digital prescribing, male contraception.
- The impact of menstruation and gynaecological conditions on educational outcomes and attainment, and on workforce participation and sick absence.
- How service provision can be more sensitive to the additional needs of inclusion health groups, including through community participation.
- How new models of commissioning and delivery of care (e.g., digital provision, at home early medical abortion) might impact on choice, access to care and reproductive health outcomes.
- Links between reproductive health events e.g., abortion and the menopause, and other social and health outcomes e.g., domestic abuse.
Since there is already a PRU on Maternal and Neonatal Health and Care, research related to pregnancy and maternal health will be out of scope of the core programme of the RH PRU. However, some research topics may benefit from collaborative work with other relevant units such as the Healthy Ageing, Public Health and the Maternal and Neonatal Health units.
Section 2: Details of policy context and background
The government is committed to improving reproductive health and wellbeing across the life course, which is a key aim of the planned Women’s Health Strategy (WHS) and planned Sexual and Reproductive Health (SRH) Action Plan. The RH PRU will support the work of the Department of Health and Social Care (DHSC) (including the Office for Health Improvement and Disparities (OHID)), NHS England and regional public health teams to meet this ambition. The RH PRU will play a vital role in supporting the successful implementation of both the WHS and SRH Action Plan with research outputs that will inform the current policy direction, as well as future government policy.
The research programme will build on findings from the 2021 Women’s Health Strategy (WHS) call for evidence and an upcoming survey of reproductive health experiences (information on the forerunner of the survey is included in this PHE report). The research programme will support an evidence-based policy approach to improving reproductive health across the system.
The proposed programme of policy research aligns with the following government priorities and commitments:
- Taking a life course approach to policy design that centres on the changing needs of the individual across their lives, rather than specific conditions or issues, as set out in the WHS.
- The Secretary of State’s commitment to tackling health disparities and embedding prevention across the NHS.
- The aims of the Health and Social Care Integration White Paper that seeks to join up care and support greater collaboration across the health and care system.
Section 3: Justification for research topics
Taking a life course approach to research on reproductive health policy and service design is supported by the World Health Organisation and the Royal College of Obstetricians and Gynaecologists (RCOG) in their report Better for Women.
Health systems and new models of care: Most reproductive health care is still structured around episodic care and commissioning responsibilities are split between NHS and Local Authorities, leading to fragmented commissioning and delivery. Stakeholders such as the royal colleges have called for more integrated commissioning and support for new models of care such as Women’s Health Hubs that are currently being evaluated via National Institute for Health and Care Research (NIHR) funded research. There has also been a significant increase in the use of digital provision as a result of the COVID-19 pandemic. More research is needed to understand the impact of these changes on patient outcomes and existing commissioning structures.
Disparities in reproductive health service access and outcomes: Routine data collection does not provide the granularity needed to assess access and uptake of reproductive health services across protected characteristics such as ethnicity and disability, and across inclusion health groups such as sex workers, and homeless and prison populations, leaving significant gaps in our understanding of reproductive health disparities. We do know that women living in the most deprived areas are more than twice as likely to have abortions than women living in the least deprived areas and that rates of long-acting reversible contraception use also show significant geographical variation. Furthermore, the call for evidence highlighted a lack of trust in the healthcare system among certain populations which could drive some observed disparities. In addition, black respondents were much less likely to rely on GPs or healthcare professionals for information than all other ethnic groups, indicating specific barriers to service access.
User experience and preferences: Limited research exists on reproductive health experiences and preferences inside and outside of healthcare settings, and there is evidence that services do not always respond appropriately to user needs. For example, 84% of respondents to the WHS call for evidence said that there had been instances in which they had not been listened to by healthcare professionals when seeking support for issues such as menstrual pain and gynaecological symptoms. This reinforces findings from other independent reports and inquiries, including the recent APPG report into Access to Contraception, APPG report into Endometriosis, the RCOG Better for Women Report, and the Independent Medicines and Medical Devices Safety Review. In addition, a recent survey of over 3,000 women across the UK found that one third of respondents were unable to access contraception from their preferred source and that not all providers were able to offer a choice of all methods (Better for Women report; see also French and others, 2017; Geary and others, 2016).
Prevention and self-management: There are gaps in high quality information on reproductive health issues across the life course, and the analysis of the WHS call for evidence responses found that awareness of common conditions and which symptoms are ‘normal’ is low, e.g., heavy menstrual bleeding, pelvic pain, menopause. This is compounded by taboos and stigmas which surround menstrual and gynaecological health and care, as well as access to abortion care and contraception for certain groups. This causes delays in accessing the right care at the right time (including self-care).
Section 4: Other related research activity of which the Unit will need to be aware
There are several planned and ongoing NIHR funded projects that the reproductive health PRU should be aware of including research into:
- Clinician’s perspectives of listening to women’s health- menstrual and gynaecological conditions (such as polycystic ovary syndrome (PCOS)), menopause, and women’s cancers.
- An ongoing evaluation of women’s health hubs, which bring together various sexual and reproductive health services in one place.
- Planned research into the long-term impact of the COVID-19 pandemic on people’s access to and attitudes towards contraception.
- The theme of the current Health and Wellbeing Fund (2022/25) is Women’s Reproductive Wellbeing in the Workplace.
- The Office for Health Improvement and Disparities is commissioning a second Reproductive Health Experiences Survey to be carried out in late 2022.
- The fourth round of the National Surveys of Sexual Attitudes and Lifestyles (NATSAL) that includes several questions on reproductive health, will conduct fieldwork in 2022 and 2023.
- The Faculty of Sexual and Reproductive Healthcare (FSRH) clinical studies group develops and provides guidance for clinical and behavioural science research studies to improve the SRH of all people.
Section 5: Other issues relevant to this programme of research
On 17 June 2022 Dame Lesley Regan was appointed to be the UK’s first Women’s Health Ambassador to support implementation of the WHS. The ambassador’s initial focus will be on those areas of health and wellbeing relevant to reproductive health including menopause and improving access to contraception.